Received a fascinating comment on my 29 Ways to Lift Your Tongue post.
“Check into this but from what I was just told by my mentor is that Nitro Spray doesn’t have to go under the tongue. You can just spray it like breath spray or aim for a cheek. I haven’t checked but it’s even says it on the insert.”
I went to the insert myself and here’s what it said:
“…spray onto or under the tongue.”
and later:
…”preferably onto or under the tongue.”
Here’s a web site for NITROLINGUAL that says the same thing.
But my Emergency and Critical Care Pocket Guide
Nitrogylcerin spray (NITROLINGUAL) 1-2 sprays 90.4 – 0.8 mg) under the tongue.
However, the American Heart Association ACS Guideline says nitro “sublingual, spray or IV” which suggests sublingual and spray are not one and the same. It later says, “patients with ischemic chest discomfort may receive up to three doses sublingual or aerosol nitroglycerin…”
I did a random sample of several medics today and everyone told me they spray NTG under the tongue. It’s supposed to be sublingal, they said.
Yeah, that’s what I always thought, but…
While I haven’t talked to a ED doctor yet, the evidence based on the insert and the AHA is pretty clear to me that spraying on the tongue (Lingual)is acceptable.
While I may continue to ask patients to lift up their tongue. If they don’t. I’m just going to spray their tongue. Barring of course any new information or edicts from my medical control. I’ll post an addendum after I’ve had a chance to ask them.
Thanks again to the commentator for pointing this out. You learn something new everyday it seems.
I am curious how many other medics out there knew about this. In the days before the spray everything was always sublingual. When we got the spray, maybe we all assumed Nitro was still sublingual. For you newer medics, what were you taught in school?